Coho Functional Medicine Approach to Anxiety & Depression: How to Stop the Spiral & Feel Better Now

How to start reclaiming your life from anxiety and depression

If you’re reading this, you may be struggling with anxiety and / or depression and are already aware of how it’s affecting your life.

Maybe you’ve also heard about how a Functional Medicine approach to anxiety and depression can help.

Perhaps you’re taking medication as well, and have noticed some improvement, or sadly, it’s been of no help whatsoever (which is all too common). 

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You may be reading this as someone who is concerned for a loved one struggling with anxiety or depression, and wondering how best you can help. 

Unfortunately, conventional medicine is failing us. 

While most doctors are doing their very best, the conventional medical approach is failing so many people suffering with anxiety and depression.

Table of Contents

Anxiety & depression statistics

Depression and anxiety rates have been increasing since 1990 – despite an increase in proven interventions being used by healthcare practitioners (1).

So clearly, the conventional medical approach (alone) is not the answer.

In our clinical experience, we need a personalised, root cause approach, based on the identifiable underlying imbalances there are at play.

While this approach isn’t as straight forward as taking a pill, it’s more likely to work.

The statistics relating to depression and anxiety prevalence are shocking.

Here’s an example of a few of them:

With so much uncertainty in the world (such as the recent pandemic, wars, increase in cost of living) it’s easy to understand the factors that might be involved in the increased incidence of mental health problems.

Children can struggle with health worries, difficult family and friend situations, or exam pressures, and may find that these concerns manifest in changes in their mood and behaviour.

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Signs and symptoms of the most common types of anxiety and depression

Some of the signs and symptoms for the most common types of depression and anxiety can be relatively subtle and may not be obvious straight away.

It could be that loved ones recognise that something isn’t quite right and be the one to flag initial concerns.

Symptoms can progress to the point where they are significantly affecting quality of life. 

The psychological symptoms of depression include:

The physical symptoms of depression include:

The social symptoms of depression include: 

Signs and symptoms of generalised anxiety disorder include:

The conventional medicine approach to anxiety & depression

SSRIs (selective serotonin reuptake inhibitors) are the most commonly prescribed anti-depressant in conventional medicine.

This class of medications include citalopram, fluoxetine and sertraline, and work by increasing the availability of serotonin – the mood supportive neurotransmitter (chemical messenger). 

This can be amazing if it works for an individual, but unfortunately it is ineffective in many people, or can actually make symptoms worse.

This is most likely because in cases where SSRIs don’t work, the root cause of their depression isn’t because they have a serotonin deficiency.

In fact, research suggests that only about 25% of people diagnosed with depression have abnormally low levels of neurotransmitters, so the theory that depression can be cured by addressing neurotransmitter imbalances for most people, is flawed. 

A study published in the journal Molecular Psychiatry in 2022 indicated there is little evidence to suggest that depression is caused by chemical imbalances in the brain (10).

Our knowledge of the mechanisms involved in depression and anxiety has increased dramatically, yet how doctors treat these conditions hasn’t changed in decades.

This should be ringing alarm bells everywhere!

The Functional Medicine approach to anxiety and depression

In our Functional Medicine approach to anxiety and depression, we look beyond medications that increase the availability of neurotransmitters. 

Let’s take a look at just a few of the additional evidence-based causes of depression and anxiety, where commonly prescribed medications would be of little benefit.

The Coho Functional Medicine approach to anxiety and depression: microbiome, inflammation and mood 

What happens in the gut affects how we feel, and vice versa. 

For example, approximately 57% of people with IBS tend to also have anxiety or depression.

The latest research into mental health largely focuses on the microbiome – mood association, which is often referred to as the gut-brain link or axis.

With the brain and the gut working in a bi-directional manner, one could affect the other’s functions and significantly impact stress, anxiety, depression, and cognition (11).

For instance, around 100 trillion microbes, from a thousand diverse species, reside in the human gut.

These bacteria are affected by our food choices, lifestyle, medications, genes, and stress (12).

A healthy gut microflora sends signals to the brain through several pathways, under stable or stressful conditions (13). 

These pathways and brain signalling have led to recognition of the role of the microbiome in managing mental health issues.

Unfortunately, conventional medicine isn’t close to implementing this new research, which is why the Coho Functional Medicine approach to anxiety and depression is much more likely to achieve better results.

One mechanism involves lipopolysaccharides (LPS) which are produced by some gut bacteria.

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LPS in turn can activate inflammatory responses that send signals that impact our stress hormones, which consequently effects behaviour.

Another mechanism at play is that an imbalanced microbiome (or poor gut function), can result in inflammation, which increases the inflammation in the nervous system (neuroinflammation), and this in turn impacts mood (14).   

This involves the kynurenine pathway which can be assessed through the advanced testing we have available.

The chemicals produced by specific gut bacteria can also influence mood, for example some gut bacteria produce histamine which can manifest as generalised anxiety (15).

Interestingly, inflammation in the body, from any source, can affect the nervous system and brain chemistry. 

An inflammatory response consists of immune molecules called cytokines, and increased cytokines such as TNF-alpha (tumour necrosis factor-alpha) and IL-6 (interleukin-6) have been linked to depression (16).

High IL-6 levels in children aged 9 was correlated with increased depression at age 18 (17) and an adult study showed that high CRP (a non-specific inflammatory marker, commonly tested by conventional doctors) and high IL-6, predicted cognitive symptoms of depression 12 years later (18).

In the Coho Functional Medicine approach to anxiety and depression, we consider various personalised strategies to assess for the presence of inflammation, and if present, reduce the inflammatory response by understanding and eliminating the drivers.

Several studies have noted an improvement in depression and anxiety with the use of curcumin (an extract from the spice, turmeric), in supplement form (19) which is probably the single most powerful anti-inflammatory food extract available.

The Functional Medicine approach to anxiety and depression: stress

The stress hormone signalling pathway from the brain to the adrenal glands (sitting on top of the kidneys), can be affected by numerous factors including physical, physiological, mental and emotional stressors. 

Imbalances in this pathway (the hypothalamus-pituitary-adrenal (HPA) axis), can be the root cause to anxiety and/or depression.  

This pathway can be assessed through Functional testing and can then be specifically supported through targeted nutritional and lifestyle interventions.

Stress comes in many forms, and prolonged stress can ultimately lead to poorer lifestyle choices and coping mechanisms.

We can find that our ability to tolerate stress declines, and stressful situations that once felt manageable, now feel overwhelming.

Supporting the HPA axis and optimising stress hormones (cortisol and DHEA) can be life changing, and we’ve experienced this with so many clients over the years (including hundreds of ‘burnt out’ professionals).

Check out this sample report of the DUTCH Adrenal test:

Chronic stress is often self-medicated with poor food choices, high sugar, alcohol or recreational drug use, perpetuating the stress hormone imbalances.

High stress also has an inflammatory consequence, circling back to the link between inflammation and neuroinflammation.

The Coho Functional Medicine approach to anxiety and depression: nutrient deficiencies

It goes without saying, that a poor diet, with insufficient vitamins, minerals and antioxidants, and high sugar and refined carbohydrates, isn’t going to make anyone feel great.

This impacts:

All are dependant on having the right ingredients – the correct amount of:

For example, serotonin production requires tryptophan, an amino acid, found in protein rich foods.

If you’re not getting enough dietary protein (or are not digesting it well), then ALL your neurotransmitters could be compromised.

Serotonin synthesis is also dependant on vitamins B2, B3, B6, B9, vitamin D, vitamin C, magnesium and zinc!

To make dopamine, we need tyrosine, another amino acid, and vitamins B1, B3, B6, folate, vitamin C and iron.

And there’s a specific list of nutrient requirements that are critical for the synthesis of other neurotransmitters!

If our cells cannot produce energy, then all functions and pathways are affected. 

Fuelling our mitochondria, the energy producing factories in our cells, can be a game changer for mood, energy, motivation and just about everything else that helps you to look, feel, and perform at your best.

Optimal mitochondrial function requires vitamins B1, B2, B3, B5, magnesium, coenzyme Q10, iron, alpha lipoic acid, and several other nutrients.

A meta-analysis found a significant correlation between low blood levels of magnesium and depression, across 7 studies (20).

A quick word on iron too – iron is critical for proper immune function and for energy production and is often an overlooked factor. 

Whilst checking magnesium status, we’d recommend also checking iron status.

Omega 3 fatty acids are often insufficient in those with anxiety and depression, particularly if you don’t regularly eat oily fish such as salmon, mackerel, sardines and anchovies. 

Omega 3 fatty acids support cell membrane function (which improves cell to cell communication) and have anti-inflammatory actions. 

While the quick option would be to supplement with fish oil, please be aware that cheaper fish oil products are usually cheap for a reason:

We think it’s better to rely on food sources alone rather than ingesting a poor-quality fish oil supplement, which has the potential to cause more harm than good.

A quick note on medications – various medications cause a depletion of beneficial nutrients, for example statin medications taken for high cholesterol reduce coenzyme Q10 which is key for supporting energy production.

The Coho Functional Medicine approach to anxiety and depression: neurotransmitter imbalances & genetics

The conventional medicine approach to anxiety and depression is based on neurotransmitter imbalances.

SSRIs prolong the length of time serotonin is available for use, the theory being that the more serotonin there is, the better we will feel.

If you do have low serotonin, then this can be helpful. 

When taking a more natural approach, we can increase serotonin by increasing the levels of nutrients required for serotonin synthesis, through diet and / or nutritional supplements.

Supporting the microbiome, where most of the serotonin is produced, can also be extremely effective.

Microbial diversity in the gut can be supported through:

How much of a particular neurotransmitter we naturally synthesise in the body depends on diet, lifestyle, gut health and our genetics.

Understanding individual genetics pertaining to the nervous system, is fundamental to personalised medicine.

We’re so grateful for tests such as LifeCode Dxs’ Nervous System Report, that explores the key genes required to be able to produce various neurotransmitters and the genes involved in breaking down neurotransmitters, check out the sample report here:

Other neurotransmitters that may require support are dopamine, GABA and acetylcholine.

Low dopamine levels may be linked to anxiety and depression (as well as other symptoms).

The dopamine system regulates cognitive functions, motivational behaviour, and pleasure (21).

Several studies have demonstrated reduced levels of dopamine in depression where there is anhedonia (a lack of pleasure or interest), for example less of an intertest in previous hobbies, or not enjoying spending time with family or friends.

Dopamine levels can be assessed and supported through diet and supplements.

Depression & anxiety: supportive therapies

Supportive therapies for anxiety and depression include:

And are proven techniques to help improve depression and/or anxiety, either alone, or in combination with other therapies.

In our clinical experience, they are well worth exploring as part of an integrated, holistic and evidence-based approach. 

Many of these strategies are working to support the HPA axis and reduce inflammation, two mechanisms commonly implicated in depression and anxiety as discussed above.

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The wrap...

Depression and anxiety symptoms can be all consuming, there are more bad days than good days, and the symptoms can leave us feeling hopeless.

Not only is it soul destroying for the person struggling with these symptoms, it’s also heart breaking for loved ones who want to help. 

While medications can offer some benefit, there is SO much more that can be done to reduce anxiety and depression symptoms by addressing underlying imbalances – these are proven strategies that are more likely to work, than not. 

We strongly believe that you should know about these options, so you can make the best informed decisions to help yourself or a loved one who is struggling with depression and/or anxiety.

We’d love to help you on your journey back to feeling at your personal best – if you’re ready to take action and explore how Functional Medicine can change your life, book your free 15 minute discovery call now.

To your optimised, healthy future,

Dee & the Coho Health team

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